Intraocular Research Articles

Accuracy assessment of artificial intelligence IOL calculation formulae: utilizing the heteroscedastic statistics and the Eyetemis Analysis Tool.

To analyse the accuracy of artificial intelligence (AI)-driven intraocular (IOL) calculation formulae, together with established formulae using the heteroscedastic methodology and the Eyetemis Analysis Tool. Data from 404 eyes who underwent uneventful phacoemulsification with implantation of the SN60WF IOL were retrospectively reviewed. IOL power calculations were performed using the Barrett Universal II (BUII), EVO 2.0, Hoffer QST, K6, Ladas Super Formula (LSF), Nallasamy, PEARL-DGS and RBF 3.0 formulae. The SD of the prediction error (PE), served as the primary metric for accuracy. The mean absolute deviation (MAD) and the predictability rates within intervals from ±0.25 D to ±1.50 D were also evaluated. The Eyetemis Analysis Tool was used for further validation. The SD ranged from 0.468 (Nallasamy) to 0.510 (LSF). The Nallasamy formula had a significantly lower SD than the BUII (0.505, p = 0.025) and K6 (0.489, p = 0.022) formulae. The Nallasamy formula also exhibited the lowest MAD (0.358) with a significant difference compared with the Hoffer QST formula (0.384, p < 0.001). Finally, a significantly higher percentage of eyes achieving ± 0.50 D of the target refraction was seen using the Nallasamy formula (77.19%) compared with the Hoffer QST (71.04%, p = 0.019) and Ladas Super Formula (70.79%, p = 0.030) formulae. The Nallasamy formula, incorporating AI technology, demonstrated superior accuracy according to the analysis guidelines for PE statistics for non-gaussian datasets recommended by Holladay et al. and the online Eyetemis Analysis Tool.

A Phase I/II Study Evaluating the Safety, Tolerability, Pharmacokinetics, and Preliminary Antitumor Activity of BTK Inhibitor HZ-a-018 in Adult Patients with Relapsed and/or Refractory Central Nervous System Lymphoma

Background: HZ-A-018 is a highly selective and potent covalent BTK inhibitor with CNS-penetrating profile, which was previously reported (Abstract 5501, ASH 2022). Phase I/II study is ongoing in China, and here we present preliminary results of HZ-A-018 monotherapy of the phase I part in central nervous system lymphoma. Methods: HZ-A-018-102 is an ongoing phase I/II study (CTR20210181) to evaluate the safety, tolerability, pharmacokinetics, and antitumor activity of HZ-A-018 in central nervous system lymphoma. The primary objective for phase I monotherapy was to determine the safety and tolerability and the recommended phase 2 dose (RP2D), and secondary objectives included preliminary antitumor activity and pharmacokinetics in patients with relapsed/refractory primary/secondary CNS lymphoma (R/R PCNSL/SCNSL) and primary vitreoretinal lymphoma (PVRL) who had received ≥1 prior therapy. HZ-A-018 was administered orally once daily in 28-day cycles until disease progression or unacceptable toxicity. Results: At the data cutoff date of 30 May 2023, 21 pts from the phase I monotherapy were analyzed, including 18 R/R PCNSL and 3 R/R SCNSL. 3 pts received 300mg/d, 12 pts received 450mg/d and 6 pts received 600mg/d. 600mg was the highest dose pre-defined in the study and MTD was not reached. Pts were with a median age of 62 years (range: 36-80), median KPS 80 (range: 60-90) and a median of 2 prior systemic therapies (range: 1-5). 20 pts (95.2%) presented with brain parenchyma, and 1 pt (4.8%) presented with intraocular (IO) involvement. All patients had received HD-MTX based chemotherapy, 19 pts (90.5%) had received rituximab and 1 pt had received whole brain radiation therapy (WBRT). 16 of 21 pts (76.2%) experienced a treatment related adverse event (TRAE). The most common TRAEs (≥10%) were thrombocytopenia (42.9%), neutropenia (23.8%), leukopenia (23.8%), and hypokalemia (14.3%), majority of which were grade 1 to 2. DLTs occurred in 1 pt at 450 mg/d and 1 pt at 600 mg/d. 4 pts (19.0%) had dose interruption, no pts had dose reductions, and no pts discontinued from the study due to TRAEs. The plasma and cerebrospinal fluid (CSF) pharmacokinetics showed HZ-A-018 was rapidly absorbed and could cross the blood-brain barrier with CSF HZ-A-018 concentration ranged from 5.94 to 17.5 ng/mL two hours post-dose. Of 19 pts available for tumor assessment (16 PCNSL with brain parenchyma, 1 PCNSL with IO and 2 SCNSL with brain parenchyma) and 2 pts not evaluable (1 PCNSL with brain parenchyma, and 1 SCNSL with brain parenchyma), the overall response rate (ORR) was 52.4% (95%CI: 29.8, 74.3), including 23.8% (5 pts) complete response(CR)/unconfirmed complete response(CRu), 28.6% (6 pts) partial response (PR), and 19.0% (4 pts) stable disease (SD), contributing to an 71.4% (95%CI: 47.8, 88.7) disease control rate (DCR). At 600mg/d, all 6 pts had achieved high and deep responses, contributing to 100% ORR and 50% CRR, with the 3-month duration of response (DOR) rate not reached. Dose expansion was ongoing at 600mg QD. Conclusions: These results demonstrated that HZ-A-018 was efficacious and well-tolerated in CNS lymphoma patients with high CNS penetrating profile. The monotherapy RP2D for R/R PCNSL was determined as 600 mg QD and a phase 2 R/R PCNSL registration study in China is currently planned.

A clinical trial on phakic intraocular lens for the treatment of refractive amblyopia in children and adolescents.

To analyze the demographics and clinical outcomes of posterior chamber phakic intraocular (IOL) implantation for refractive amblyopia in children and adolescents. A prospective interventional study was performed on children and adolescents with amblyopia at a tertiary eye care center from January 2021 to August 2022. Twenty-three eyes of 21 anisomyopic and isomyopic amblyopia patients operated for posterior chamber phakic IOL (Eyecryl phakic IOL) as a treatment for amblyopia were included in the study. Patient demographics, pre- and postoperative visual acuity, cycloplegic refraction, anterior and posterior segment examination, intraocular pressure, pachymetry, contrast sensitivity, endothelial count, and patient satisfaction scores were evaluated. Patients were followed up at day 1, 6 weeks, 3 months, and 1 year after surgery, and visual outcomes and complications were documented. The mean age of patients was 14.16 ± 3.49 years (range: 10-19 years). The mean intraocular lens power was - 12.20 diopter spherical (DS) in 23 eyes and - 2.25 diopter cylindrical (DC) in four patients. The mean unaided distant visual acuity (UDVA) and best-corrected visual acuity (BCVA) were 1.39 ± 0.25 and 0.40 ± 0.21 preoperatively on the log of minimum angle of resolution (logMAR) chart. Postoperatively, the visual acuity improved by 2.6 lines in 3 months period and maintained till 1 year. Postsurgery, contrast sensitivity in the amblyopic eyes significantly improved, and the average endothelial loss recorded was 5.78% at 1 year, which was statistically insignificant. Patient satisfaction score was statistically significant, with 4.736/5 recorded on the Likert scale. Posterior chamber phakic IOL is a safe, effective, and alternative method for treating amblyopia patients who are noncompliant with glasses, contact lenses, and keratorefractive procedures.

Accuracy of Six Intraocular Lens Power Calculations in Eyes with Axial Lengths Greater than 28.0 mm.

The purpose of this study was to compare the accuracy of several intraocular (IOL) lens power calculation formulas in long eyes. This was a single-site retrospective consecutive case series that reviewed patients with axial lengths (AL) > 28.0 mm who underwent phacoemulsification. The Wang–Koch (WK) adjustment and Cooke-modified axial length (CMAL) adjustment were applied to Holladay 1 and SRK/T. The median absolute error (MedAE) and the percentage of eyes with prediction errors ±0.25 diopters (D), ±0.50 D, ±0.75 D, and ±1.00 D were used to analyze the formula’s accuracy. This study comprised a total of 35 eyes from 25 patients. The Kane formula had the lowest MedAE of all the formulas, but all were comparable except Holladay 1, which had a significantly lower prediction accuracy with either AL adjustment. The SRK/T formula with the CMAL adjustment had the highest accuracy in predicting the formula outcome within ±0.50 D. The newer formulas (BU-II, EVO, Hill-RBF version 3.0, and Kane) were all equally predictable in long eyes. The SRK/T formula with the CMAL adjustment was comparable to these newer formulas with better outcomes than the WK adjustment. The Holladay 1 with either AL adjustment had the lowest predictive accuracy.

IOL Power Calculation in Eyes Undergoing Combined Descemet Membrane Endothelial Keratoplasty and Cataract Surgery.

To assess the accuracy of different corneal powers for intraocular (IOL) power calculation in combined Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery and investigate whether preoperative parameters correlate to the prediction error (PE). This prospective case series involved patients with Fuchs endothelial dystrophy receiving combined DMEK and cataract surgery. Preoperatively, patients underwent optical biometry and anterior segment OCT (AS-OCT). AS-OCT measurements were repeated 6 months postoperatively, when final refraction was assessed. The PE was calculated using the preoperative average keratometry (Kave) measured by the optical biometer and User Group for Laser Interference Biometry (ULIB) constants. It was also calculated, after constant optimization, using the preoperative Kave from both devices and the total corneal power (TCP) measured by AS-OCT, as well as the postoperative Kave and TCP measured by AS-OCT. ULIB constants resulted in the highest hyperopic PE (P < .0001). Constant optimization improved the results, because the PE was zeroed out and the absolute PEs decreased. No significant difference was found among the Barrett Universal II, Emmetropia Verifying Optical 2.0, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas. Further improvement was achieved with the postoperative Kave and TCP, although the accuracy remained moderate. The PE based on preoperative corneal measurements was correlated to the amount of corneal flattening; the latter could be predicted by multiple linear regression accounting for anterior and posterior corneal radii (P = .0002) and was correlated to the preoperative anterior/posterior ratio. Constant optimization is beneficial for combined DMEK and phacoemulsification. Predicting postoperative corneal flattening may improve the results of IOL power accuracy. [J Refract Surg. 2022;38(7):435-442.].

Characteristic of Secondary Intraocular Lens Implantation in Aphakic Children in Cicendo National Eye Hospital

Background: Pediatric cataract is responsible for 200.000 of preventable blindness in children. Early cataract extraction and correction after the lens removal is critical. Secondary intraocular (IOL) implantation might be considered when the child is intolerant to contact lenses/spectacle wear. Only a few study has been done regarding secondary IOL implantation in aphakic children. Objective: This study was aimed to describe the characteristic of secondary IOL implantation in aphakic children in Cicendo National Eye Hospital. Methods: This retrospective observational study took samples from medical records of patients who underwent secondary IOL implantation in 2016 – 2020 in Cicendo National Eye Hospital. Results: Fifty nine eyes of forty pediatric patients underwent secondary IOL implantation surgery between 2016 – 2020. Two patients were excluded. From the 38 patients, 56 eyes were observed. Total of 20 patients were boys (52.6%) and 71.1% cases were bilateral cataract with congenital cataract as the main initial diagnosis (47.4%). Mean age of secondary IOL implantation was 71 ± 35 (20–201) months. Mean duration between cataract surgery and secondary IOL implantation was 51 ± 36 (2 – 189) months . Total of 80.4% of the IOL were fixated in the sulcus. Only 25% remained present for more than 12 months follow up and 65.8% of patients were corrected with bifocal spectacles. Conclusion: Secondary IOL implantation in aphakic children were mostly done in the age of six years old. Most of the IOL were fixated in the sulcus. Patients were mostly given bifocal spectacles.

Comparison of extraocular and intraocular pressure transducers for measurement of transient intraocular pressure fluctuations using continuous wireless telemetry

The optimal approach for continuous measurement of intraocular pressure (IOP), including pressure transducer location and measurement frequency, is currently unknown. This study assessed the capability of extraocular (EO) and intraocular (IO) pressure transducers, using different IOP sampling rates and duty cycles, to characterize IOP dynamics. Transient IOP fluctuations were measured and quantified in 7 eyes of 4 male rhesus macaques (NHPs) using the Konigsberg EO system (continuous at 500 Hz), 12 eyes of 8 NHPs with the Stellar EO system and 16 eyes of 12 NHPs with the Stellar IO system (both measure at 200 Hz for 15 s of every 150 s period). IOP transducers were calibrated bi-weekly via anterior chamber manometry. Linear mixed effects models assessed the differences in the hourly transient IOP impulse, and transient IOP fluctuation frequency and magnitude between systems and transducer placements (EO versus IO). All systems measured 8000–12,000 and 5000–6500 transient IOP fluctuations per hour > 0.6 mmHg, representing 8–16% and 4–8% of the total IOP energy the eye must withstand during waking and sleeping hours, respectively. Differences between sampling frequency/duty cycle and transducer placement were statistically significant (p < 0.05) but the effect sizes were small and clinically insignificant. IOP dynamics can be accurately captured by sampling IOP at 200 Hz on a 10% duty cycle using either IO or EO transducers.

Safety and Efficacy of a New Posterior Chamber Phakic Intraocular Lens in Cases of High Myopia: Early Results.

PurposeTo demonstrate the visual outcomes of a foldable, hydroxy ethyl-methacrylate, single-piece, posterior chamber phakic intraocular lens (pIOL).Study TypeRetrospective study.Materials and MethodsPatients presenting with moderate to high myopia who underwent surgical correction with a posterior chamber phakic IOL (refractive intraocular lens, phakic intraocular lens, Appasamy Associates, Chennai, India) were retrospectively reviewed. Only patients with at least one-year follow-up were included. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), endothelial cell density (ECD), and pIOL vault were analyzed 1, 3, 6, and 12 months after surgery. Intraoperative and postoperative events were recorded in all cases.ResultsThe study included 30 eyes from 15 patients. The mean patient age was 25.8 ± 3 years. The spherical equivalent of manifest refraction was −11.47 ± 4.38 D preoperatively and −0.44 ± 0.55 D postoperatively. The preoperative CDVA was 0.17 ± 0.12 logMAR. The postoperative UDVA was 0.053 ± 0.11 logMAR (min: −0.17 and max: 0.2) and 0.019 ± 0.091 logMAR (min: −0.17 and max: 0.2) at the end of 1 month and 6 months, respectively. At the end of the 12-month visit, the postoperative UDVA was 0.032 ± 0.094, and the safety index was 2.42. The mean ECD was 2639 cells/mm2 (min: 2389 and max: 2993 with SD: 139.53) at the preoperative visit and 2445 cells/mm2 (min: 2050 and max: 2701) at the 12-month visit (5.8% loss, p less than 0.001). ECD loss from 6 months to 12 months was not statistically significant. No significant cataract formation, significant endothelial cell loss, glaucoma, uveitis, or any other vision-threatening complication were observed.ConclusionBased on postoperative experience, we found that RIL phakic IOLs are safe and effective for treating high myopia at short-term follow-up.

Comparing the effect of three Descemet membrane endothelial keratoplasty injectors on endothelial damage of grafts.

Purpose:Various injectors are commercially available for Descemet membrane endothelial keratoplasty (DMEK) but not all injectors have been studied for endothelial damage of grafts. The aim of the study was to compare endothelial damage in pre-stripped DMEK tissue from three clinically used injector devices: the modified Jones tube, the STAAR intraocular (IOL) injector, and the Geuder glass cannula in a laboratory setting.Methods:Twenty-four human donor corneas were used for this study, eight for each study arm. Each endothelial graft was pre-stripped, trephined to 8.0 mm diameter, then loaded into either the modified Jones tube, the STAAR IOL injector, or the Geuder glass cannula by an eye bank technician who had no prior experience with any of the injectors. Grafts were then ejected, stained with Calcein acetoxymethyl (AM), and quantitatively analyzed using FIJI image software. The primary outcome was the percent of endothelial damage from injector loading and injection. Donor demographics were analyzed using Fisher’s exact test. The percentage of endothelial cell loss was compared across groups using the Kruskal–Wallis test.Results:The mean percent of endothelial damage from after injection of the graft was 37.8% (±SD 12.2%) for the modified Jones tube, 37.0% (±SD 13.9%) for the STAAR IOL injector, and 23.5% (±SD 5.1%) for the Geuder cannula (P = 0.008).Conclusion:DMEK injectors contribute to intraoperative endothelial damage of transplanted grafts. The Geuder glass cannula may offer increased ease of use and less endothelial damage compared to the modified Jones tube or STAAR IOL injector for the novice user in early cases.

Immunotherapy and systemic chemotherapy for the treatment of intraocular lymphoma. Indications and results

AbstractPrimary vitreo‐retinal lymphoma (PVRL), which is part of the primary central nervous system lymphoma (PCNSL) group, is a rare presentation with a dismal prognosis. In addition to the functional prognosis on the vision, PVRL are at high risk of dissemination in the CNS. The therapeutic management of PVRL remains controversial, ranging from local treatment, systemic chemotherapy and even intensive chemotherapy with autologous stem cell transplantation. Targeted therapies have recently shown encouraging result in relapse or refractory PVRL. We will review the different options for systemic treatments of PVRL in front‐line and at relapse and highlight the needs for improving the outcome of patients with PVRL. Although intra‐ocular (IO) involvement of PCNSL does not appear to worsen the prognosis of PCNSL, the management of IO involvement is still controversial and suboptimal.

Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes.

To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes. A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included. In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°. Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.

Chitosan-adjuvanted Mycoplasma gallisepticum bacterin via intraocular administration enhances Mycoplasma gallisepticum protection in commercial layers.

Mycoplasma gallisepticum (MG) causes respiratory signs and economic losses in the poultry industry. MG vaccination is one of the effective prevention and control measures that have been used around the world. Our previous study demonstrated that chitosan-adjuvanted MG bacterin could effectively reduce pathological lesions induced by MG and that chitosan could be used as an adjuvant in MG bacterin. The present study determining the efficacy of MG bacterins against the Thai MG strain was based on vaccine programs. Seven groups (25 layers/group) were received MG bacterins containing 0.5% chitosan or a commercial bacterin via intramuscular (IM) or intraocular (IO) route at 6 and 10 wk of age. Sham-negative and sham-positive controls were groups 1 and 2, respectively. Group 3: IM route of chitosan bacterin followed by IM route of chitosan bacterin; group 4: commercial bacterin via IM route followed by chitosan bacterin via IO route; group 5: commercial bacterin via IM route followed by commercial bacterin via IM route; group 6: chitosan bacterin via IM followed by chitosan bacterin via IO route; and group 7: chitosan bacterin via IO route followed by chitosan bacterin via IO route were determined. At 16 wk of age, all groups, excluding group 1, were challenged intratracheally with 0.1mL containing Thai MG strain 107 colony-forming unit. At 17, 18, and 20 wk of age, 5 birds in each group were bled for serological testing and swabbed at the choanal cleft for the quantitative real-time PCR assay, the euthanized and necropsied. The results showed that birds vaccinated with a commercial intramuscular bacterin followed by an intraocularly chitosan adjuvant bacterin showed the best protection against the MG challenge. The study indicated that chitosan could be the effective mucosal adjuvant and increased the effectiveness of MG bacterin.

Adipose mesenchymal stem cells-derived exosomes attenuate retina degeneration of streptozotocin-induced diabetes in rabbits.

This study aimed to evaluate the effect of mesenchymal stem cells (MSCs)–derived exosomes in retina regeneration of experimentally induced diabetes mellitus (DM) in a rabbit model. Exosomes are extracellular vesicles that contain many microRNAs (micRNAs), mRNAs, and proteins from their cells of origin. DM was induced by intravenous (IV) injection of streptozotocin in rabbits. MSCs were isolated from adipose tissue of rabbits. Exosomes were extracted from MSCs by ultracentrifugation. Exosomes were injected by different routes (IV, subconjunctival (SC), and intraocular (IO)). Evaluation of the treatment was carried out by histopathological examination of retinal tissues and assessment of micRNA-222 expression level in retinal tissue by real-time polymerase chain reaction. Histologically, by 12 weeks following SC exosomal treatment, the cellular components of the retina were organized in well-defined layers, while IO exosomal injection showed well-defined retinal layers which were obviously similar to layers of the normal retina. However, the retina appeared after IV exosomal injection as irregular ganglionic layer with increased thickness. MicRNA-222 expression level was significantly reduced in diabetic controls when compared to each of healthy controls and other diabetic groups with IV, SC, and IO routes of injected exosomes (0.06 ± 0.02 vs. 0.51 ± 0.07, 0.28 ± 0.08, 0.48 ± 0.06, and 0.42 ± 0.11, respectively). We detected a significant negative correlation between serum glucose and retinal tissue micRNA-222 expression level (r = −0.749, p = 0.001). We can associate the increased expression of micRNA-222 with regenerative changes of retina following administration of MSCs-derived exosomes. The study demonstrates the potency of rabbit adipose tissue–derived MSCs exosomes in retinal repair. So, exosomes are considered as novel therapeutic vectors in MSCs-based therapy through its role in shuttling of many factors including micRNA-222.

Ocular biometric changes with different accommodative stimuli using swept-source optical coherence tomography.

To evaluate ocular biometric changes with different accommodative stimuli using a new swept-source optical biometer. Only the right eye was analyzed. Each subject was measured six times with the IOLMaster 700 swept-source optical biometer (Carl Zeiss Meditec, Jena, Germany) with the subject looking at the stimulus shown by the instrument and with the subject looking at a target placed outside the instrument at 0D of vergence. Axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT), lens thickness (LT), white-to-white (WTW), and keratometry readings (K1 and K2) were evaluated in both cases. To assess if the changes found may affect the intraocular (IOL) power calculation for surgical applications, we have applied some formulae, using the software provided by the optical biometer manufacturer, to the ocular parameters found in both situations for three different types of IOLs. No statistically significant differences were found for AL, CCT, WTW, K1 and K2 between the subject looking at the stimulus of the biometer and looking at the outside target at 0D of vergence (p>0.05). However, the measurement of ACD revealed a statistically significant reduction of 20 microns (p=0.03) and, on the contrary, LT increased significantly 30 microns (p=0.02). ACD and LT changes were highly correlated (R2=0.91). As for the IOL power calculation, in all cases, the mean change was lower than 0.25 D both for IOL power selection and residual refraction. Although ACD and LT change significantly with different accommodative stimuli measured by swept-source optical biometry, these changes are not clinically relevant.

Improving the preoperative prediction of the anterior pseudophakic distance for intraocular lens power calculation

To establish a new formula for intraocular (IOL) power calculation. Private practice, Lynwood, California, USA. Retrospective observational and prospective evaluation. In this 2-part retrospective observational study followed by a prospective evaluation, the postoperative anterior pseudophakic distance (APD) was correlated with the ante-nucleus distance (AND), the nucleus thickness (NT) of the cataractous lens, and the axial length. An estimated APD (EAPD) equation was established and used prospectively in a new formula on eyes scheduled for cataract surgery. Correlations were made in 90 operated eyes, and the EAPD equation was used in a new formula on 110 eyes scheduled for cataract surgery. Using the new IOL power formula, the median absolute error was 0.28 D with 82.7% of the eyes within ±0.50 D and 100% within ±1.00 D. The new IOL power formula with its incorporated EAPD equation performed well. H.J.S. has a pending patent on this system and method for determining IOL lens power.

Correlation of Macular Choroidal Thickness with Concentrations of Aqueous Vascular Endothelial Growth Factor in High Myopia

Purpose: To investigate the association of both aqueous and serum vascular endothelial growth factor (VEGF) levels and macular choroidal thickness in high myopia.Materials and methods: VEGF concentrations were measured in aqueous and serum samples via enzyme-linked immunosorbent assay (ELISA) and compared between high myopia (n = 36 eyes, 36 patients) and normal control (n = 42 eyes, 42 patients) eyes. Macular choroidal thickness, the distance from the retinal pigment epithelium (RPE) to the scleral interface, was determined via enhanced depth-imaging optical coherence tomography (EDI-OCT). Axial length was measured using the intraocular (IOL) lens Master.Results: Aqueous levels of VEGF from high myopia patients were significantly lower compared with those from control persons (61.4 ± 27.6 versus 122.6 ± 52.4 pg/ml; p < 0.001), respectively. Macular choroidal thickness of high myopia patients was significantly lower compared with that of control persons (111.1 ± 45.0 versus 230.6 ± 81.8 μm; p < 0.001), respectively. Aqueous levels of VEGF were significantly associated with both macular choroidal thickness (R2 = 0.641; p < 0.001) and axial length (R2 = 0.679; p < 0.001) in high myopia patients. In addition, there was a significantly negative correlation between macular choroidal thickness and axial length (R2 = 0.69; p < 0.001). However, no correlation between serum VEGF and either macular choroidal thickness or axial length was detected in high myopia patients (R2 = 0.009; p = 0.59; R2 = 0.00002; p = 0.981).Conclusions: Macular choroidal thickness was significantly correlated with aqueous, but not serum, levels of VEGF in highly myopic eyes. Macular choroidal thickness may be of predictive value for identifying aqueous VEGF levels in high myopia patients and may, thus, be a useful prognostic modality.

Influence of intraocular lens haptic design on refractive error

To assess the influence of intraocular (IOL) haptic design on the refraction prediction error in patients having cataract surgery. Private practice. Comparative case series. Corneal power and axial length were measured with the same devices in eyes with a 3-piece Acrysof IOL and eyes with a 1-piece Acrysof IOL and were entered into the Haigis, Hoffer Q, Holladay 1, and SRK/T formulas. The median absolute error and mean absolute error in refraction prediction (ie, difference between expected refraction and actual refraction) were assessed 1month postoperatively. The study evaluated 110 eyes with the 3-piece IOL and 84 eyes with the 1-piece IOL. With all formulas, the median absolute error was lower with the 3-piece IOL. It ranged between 0.15 diopter (D) (Haigis and Holladay 1) and 0.19 D (SRK/T) with the 3-piece IOL and between 0.23 D (Haigis) and 0.30 D (SRK/T) with the 1-piece IOL. With all formulas, a higher percentage of eyes with the 3-piece IOL were within ±0.25 D and ±0.50 D of the target refraction. Three-piece IOLs may yield better refractive outcomes than 1-piece IOLs. A possible reason is that once the early forward IOL shift previously observed with the 3-piece design occurs because of the haptic-compression force decay typical of these IOLs, the rigid haptics of 3-piece IOLs still exert more pressure against the capsular bag than the haptics of 1-piece IOLs. Therefore, 3-piece IOLs may better resist subsequent capsule contraction and provide a more predictable effective lens position. Dr. Hoffer receives royalties for his book IOL Power, Slack, Inc., and formula royalties from all manufacturers using the Hoffer Q formula. No other author has a financial or proprietary interest in any material or method mentioned.

LIO pseudofácica suplementar sulcoflex® toric sobre LIO acrysof® toric

To correct a high hyperopia and irregular astigmatism secondary to multiples refractive surgeries in a 45 years old female, radial incisions suture and intraocular (IOL) Acrysof Toric lens was performed. To correct the residual refractional error a pseudophakic toric supplementary IOL was implanted over the primary one.The initial visual acuity (VA) was LogMAR 0,9 and the final VA was LogMAR 0,3. The implant of IOL supplementary over a primary toric IOL appears to be a good option, increasing the visual [...]

Effect of Different Routes of Inoculation on Infectivity and Viral Shedding of LPAI Viruses in Mallards

We studied the effect of different routes of inoculation on the infectivity and duration of viral shedding in mallards (Anas platyrhynchos) infected with wild bird-origin low pathogenic avian influenza viruses (LPAIVs). One-month-old mallards were inoculated with 10(6) median embryo infectious doses of either A/mallard/MN/199106/99 (H3N8) or A/mallard/MN/355779/00 (H5N2) via 1 of 5 different routes: intranasal (IN), intratracheal (IT), intraocular (IO), intracloacal (IC), or intra-ingluvial (II). Birds in all routes of inoculation groups became infected with LPAIV as detected by virus isolation, real time reverse transcription polymerase chain reaction, and serology. Mallards in different route of inoculation groups had similar viral shedding through oropharynx and cloaca from 1 day postinoculation (dpi). The peak of oropharyngeal (OP) viral shedding was reached between 2 and 3 dpi in all routes of inoculation groups infected with either virus. The peak of cloacal (CL) viral excretion was reached between 2 and 3 dpi in all routes of inoculation groups infected with H3N8 LPAIV and in the IO-, IC-, and II-inoculated groups infected with H5N2 LPAIV, with a delayed and shorter peak for the IN- and IT-inoculated groups. The birds inoculated via the II route had more productive OP and CL viral shedding after infection with either LPAIV, as evidenced by higher number of swabs testing positive over the study period. In conclusion, mallards can be infected with LPAIV by various routes of inoculation, and this corroborates their high susceptibility to infection by these viruses.

Comparison of Long-term Visual Outcome and IOL Position With a Single-optic Accommodating IOL After 5.5- or 6.0-mm Femtosecond Laser Capsulotomy

To evaluate the long-term visual outcome and intraocular (IOL) position parameters with a single-optic accommodating IOL after 5.5- or 6.0-mm femtosecond laser capsulotomy. This prospective, randomized, pilot study comprised 17 eyes from 11 patients (7 men) with a mean age of 65.82±10.64 years (range: 51 to 79 years). All patients received a Crystalens AT-50AO (Bausch & Lomb) accommodating IOL after femtosecond laser refractive cataract surgery using either a 5.5-mm capsulotomy (5.5-mm group; 9 eyes) or 6.0-mm capsulotomy (6.0-mm group; 8 eyes). Near and distance visual acuities, manifest refraction spherical equivalent (MRSE), and IOL tilt and decentration were evaluated 1 year postoperatively. No significant differences were noted between groups for postoperative uncorrected distance visual acuity, uncorrected near visual acuity, distance-corrected near visual acuity, and MRSE. Vertical and horizontal tilt were significantly higher in the 6.0-mm group than in the 5.5-mm group (P=.014 and P=.015, respectively). No significant difference was observed between groups regarding IOL decentration. A 5.5-mm capsulotomy created with a femtosecond laser is associated with less IOL tilt and therefore may be superior to a 6.0-mm capsulotomy when implanting a single-optic accommodating IOL.